MIH-Consortium Kellie Burnam, Community Health Manager, Schertz EMS Brandon Kludt, EMS Chief, Canyon Lake Fire/EMS Chris Velasquez, MIH Coordinator, San Antonio Fire Department Richard Britz, MIH Paramedic, HIS Centre (Bulverde/Spring Branch EMS)
Objectives • Defining Mobile Integrated Healthcare • STRAC MIH Consortium • Current Members Staffing Projects Overview • Vision for the Future • Q&A
Current EMS Model Not Sustainable! Most expensive route to most expensive care
Healthcare Expenditures • 2016 – 17.9% of Gross Domestic Product, almost $3.5 Trillion • 2026 - Expected to rise to $5.7 Trillion
Growth in Major Healthcare Payers 8.0% 7.0% • Medicare – 7.4% per year 6.0% • Medicaid – 5.8% per year 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Medicare Medicaid
Institute for Healthcare Improvement Improve Patient Experience Triple Aim Reduce per Improve Health Capital Cost of of Populations Healthcare
High Utilizer Patient Cycle Patient has a medical complaint or injury Patient is Patient discharged calls 911 EMS Patient is transports treated the patient to the ER
What prevents patients from getting better? • Primary Care Continuity • Follow-up care Patient has of Care • Referral to specialists a medical complaint or injury • Home health • Therapy Patient is Patient Resources • Access to discharged calls 911 medications • Financial constraints • Disease and medications EMS • Nutrition and Education Patient is transports physical activity treated the patient • Safety to the ER • Healthcare system
Mobile Integrated Healthcare (MIH) “ the provision of healthcare using patient-centered, mobile resources in the out-of- hospital environment.” -NAEMT PATIENT NAVIGATION
Mobile Integrated Healthcare (MIH) • Reach • Teach • Educate • Assess
Low Profile Response Vehicles
Mobile Integrated Healthcare (MIH) Can address: ✓ System High Utilizers Overutilization of the 911 system Overutilization of Emergency Department ✓ Hospice Revocation ✓ Hospital Re-Admissions ✓ At-Risk Populations ✓ Address social determinants of health
Mobile Integrated Healthcare (MIH) Why EMS? Trusted resource in the Community Tied into 911 Trained to recognize emergencies and immediate life threats Comfortable in less than favorable conditions Delegated Practice (Texas) 24/7 availability Fully mobile Flexibility in projects
STRAC MIH Consortium Regional approach to MIH “One - stop shop” for organizations seeking MIH services ✓ One contract to negotiate ✓ One process ✓ One point of contact to correct issues ✓ One coverage map, made up of multiple MIH teams
Patient Care Community Local EMS Continuity of Improved Patient Focus Referral Based Care Involvement Care Health Mobile Integrated Healthcare Consortium • Utilizing agreements and relationships already in place • Minimize the financial impacts of high-utilizers and chronic care patients • Maintain a high standard of care for patients with these complex conditions • Improve the healthcare system through cost-containment • Decompress over-crowded emergency departments throughout the region • Encourage all EMS providers in the region to be members • Membership is voluntary • Member Agencies participate as appropriate for their community • Comprehensive regional membership accomplishes continuity of care * Member Agencies must be the municipal or contracted 911/Emergency Medical Service provider for the jurisdiction they serve under the MIH Program. As such, the Membership Application must be signed/recognized by the governmental authority having jurisdiction.
STRAC MIH Consortium Consortium Responsibilities: (Backbone Organization) Simplify & streamline: ✓ Contract Process ✓ Data Collection (input & output) ✓ Information Sharing ✓ Quality Improvement ✓ Regulatory Compliance
STRAC MIH Consortium MIH Chief level meetings Special project meetings Data Management
STRAC MIH Consortium • Open to all STRAC Agencies that are 911 providers • Conforms to Consortium Charter • Must have an Inter-Local Agreement (ILA) in place between STRAC & 911 provider regarding MIH • Umbrella (over-arching) agreement to do MIH work • Project-specific agreements • If choosing to participate in a project, must be able to meet all contractual requirements
HIS Centre Community Health (contracted by BSB Fire & EMS) 2016-2017 Highlights: • 1003 -Patients Fall Risk, Healthcare Navigation, High Utilizer • Wellness on Wheels (WOW) -Collaborative mobile shot clinic for community & schools • Outreach - 414 box fans distributed; medical Richard Britz, Director of supplies to Bulembu Swaiziland Community Health 2018 Initiatives: Continue current programs Focus on senior homelessness (collaborative project to build homes)
Canyon Lake Fire / EMS MIH Brandon Kludt, Division Chief of EMS Gregory Eckert, MIH Paramedic M – F (8am-5pm) MIH Services: • High Utilizer Program • Fall Prevention and Home Safety Surveys • Humana Immunizations • EMS Personnel Referrals • Community Education • Community Health Screenings
Canyon Lake Fire / EMS MIH TOTAL MIH Contacts (6 Month Pilot) 32 TOTAL MIH Contacts (Jan – Dec 2017) 101 Average Age 70 Average Age 74 Minimum Age 11 Minimum Age 11 Maximum Age 95 Maximum Age 99 Female Patients 14 Female Patients 28 Male Patients 17 Male Patients 27 Average # of Calls for Service Pre 1st MIH 5.9 Average # of Calls for Service Pre 1st MIH 5.8 Average # of Calls for Service Post 1st MIH 1 Average # of Calls for Service Post 1st MIH 1.2 • 79.3% reduction in 9-1-1 calls for service for patients that MIH intervened • 18 patients were seen during the Pilot Program (15 have transitioned out) • 41 new patients after the Pilot Program (3 carried over from Pilot Program) *This data excludes patients seen during the monthly health screenings
Canyon Lake Fire / EMS MIH Projected cost savings (call abatement) • Based on the average of 5.8 9-1-1 calls for service per patient pre MIH intervention, it can be assumed that a cumulative total of 319 9-1-1 calls for service would have been made by the 55 patients involved in the MIH Program. • Based on the average of 1.2 9-1-1 calls for service (79.3% reduction) per patient post MIH intervention, it can be assumed that a cumulative total of 253 9-1-1 calls for service were avoided by the district. • Based on the previous financial analysis and an assumption that 60% of EMS calls for service result in ED transport, the district observed a savings of $145,811.49 as a result of MIH intervention.
San Antonio FD/EMS MIH • October 2014 – pilot program began with High Volume Utilizers • May 2016 – 7 MIH Paramedics • 4 (24 Hr Shift) MIH Paramedics • 3 (40 Hr/week) MIH Paramedics • 1 Lieutenant/MIH Coordinator • Over 12,000 MIH Contacts since 2014 • Approximately 400 internal referrals from Fire in 2017
Past/Current Projects: • System High Utilizers • 2,345 high volume utilizer participants • 59% reduction in call volume • Pediatric Asthma NAIP Grant • 75 patients participated in program • Reduced ED visits, EMS calls, Hospital Admissions • Increased med compliance & PCP visits • Hospice • 96% effective in stopping unnecessary transports to the ED • Haven for Hope Project • Opioid Crisis Task Force
City of Schertz EMS MIH • Kellie Burnam, Community Health Manager • Tyler Bowker, MIH Paramedic • M – F (8am-5pm) & 24/7 On-call MIH Paramedic • Program began in 2013 • Began MIH-Consortium with SAFD & Canyon Lake FD
City of Schertz EMS MIH Past/Current Projects: • System High Utilizers • 40 patients participated since program began • Fall prevention, safety assessments • Humana Immunizations Program • Flu vaccines covered for all Humana cities in service area • Pediatric Asthma NAIP Grant • 15 patients participated in program • Reduced ED visits, EMS calls, Hospital Admissions • Increased med compliance & PCP visits • Hospice • 96% effective in stopping unnecessary transports to the ED • MIH Coordinator • Currently providing project coordination for the entire Consortium
STRAC MIH Consortium: Future State Add members to the Consortium Negotiate larger contracts to sustain programs National Model for regional approach to MIH
For more information: Kellie Burnam kburnam@Schertz.com 210-619-1430
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